General Care and Management of the Newborn
Thermoregulation
Four routes of heat loss: evaporation (wet skin), conduction (cold scale), convection (drafts), radiation (cold walls). Newborns defend temperature poorly - high surface-area-to-mass ratio, little subcutaneous fat, no shivering, limited brown adipose thermogenesis in preterm or sick infants. Interventions: dry immediately, skin-to-skin or radiant warmer, hat, delayed first bath, double-wall incubator, and intermittent axillary monitoring.
Routine care and procedures
Vitamin K 1 mg IM (0.5 mg if under 1.5 kg) in the vastus lateralis; erythromycin 0.5% ophthalmic ointment; hepatitis B vaccine; universal newborn screening after at least 24 hours of feeding (repeat if drawn earlier); hearing screening before discharge; identification bands applied before separation from the parent. Cord care is dry care - no alcohol or triple dye. Bathing waits until temperature is stable.
Circumcision
Contraindications: hypospadias or ambiguous genitalia (never excise tissue that may be needed for reconstruction), bleeding diathesis, illness, prematurity. Vitamin K must be given first, analgesia is required (dorsal penile block, topical anesthetic, sucrose, pacifier), and post-procedure observation covers bleeding, voiding, and infection.
Traps
Immediate bathing (cold stress, hypoglycemia), alcohol on the cord, circumcising before confirming normal anatomy, and screening a 12-hour-old without planning a repeat.
Rule of thumb
Cold plus wet equals evaporative loss: dry, cover, skin-to-skin, then measure.